The unprecedented push for the omicron variant is straining Colorado’s already depleted healthcare workforce, and a doctor who helped draft hospital emergency triage plans late last year said Friday that the state would benefit from adopting them now.
âFrom a staff perspective, it’s going to get worse,â said Anuj Mehta, researcher and intensive care physician at Denver Health. âWe might start to see some units closed.â¦ Closure of emergency care, closure of labor and delivery (departments). There is great potential for this in the coming weeks. It will be much more difficult to do. ‘access health care. “
Omicron has led to staggering case and positivity rates statewide, setting and resetting records in successive days. COVID-19 hospitalizations statewide are increasing after a month-long reprieve, and Colorado’s top epidemiologist told reporters on Wednesday that this wave will not peak for weeks. The wave’s impact on hospital staff may be more urgent: The wildfire-like spread of the variant, coupled with its ability to evade immunity, leads to an increase in cases of rupture among staff. health, whose ranks have already been thinned by exhaustion and burnout.
âOmicron did something that I think we all hoped would never happen but which unfortunately happens,â Mehta said. “Omicron has decimated the ranks of healthcare workers because we see so many people testing positive.”
In Denver Health, 40% of health workers who have reported recently tested positive for the virus, said Mehta and hospital spokesperson Rachel Hirsch. Fortunately, because these workers are vaccinated and because omicron usually causes less severe illness, Mehta said he was unaware that none of his recently infected colleagues became seriously ill.
But continued waves of infection mean providers routinely give up to self-isolate for at least five days, further compounding a critical staff shortage. Mehta’s wife, a primary care doctor, volunteered to work a shift in an emergency department due to understaffing; State systems and hospitals are increasingly turning to outpatient care providers, such as those in emergency or primary care clinics, to replace infected hospital workers.
Colorado Hospital Association spokesperson Cara Welch said she couldn’t say for sure the virus was infecting more providers now than in previous waves, “but it does look like it would be likely, just given the transmissibility of omicron “. As of Friday afternoon, more than half of the state’s hospitals said they anticipate a staff shortage over the next week. Welch said that number is likely an undercoverage.
Colorado epidemiologist Rachel Herlihy said this week that the virus is spreading so widely that patients hospitalized for reasons other than COVID-19 test positive at higher rates, increasing the risk of exposure for workers of health.
In November, hospital capacity was strained by the pandemic. The crisis has been centralized in hospitals but worsened by understaffing in long-term care facilities, which can serve as reduction facilities for recovering patients. Governor Jared Polis injected dozens of new beds in hospitals and long-term care facilities, which helped stabilize the situation. But long-term care staff are also falling ill now, Mehta said, and several nursing homes have recently refused admissions because they are understaffed.
âWe were already operating on very thin margins,â he continued. “… We see the wait times in emergency departments and waiting rooms stretching for several hours for low-severity issues, and then the waiting rooms are kind of packed. “
Crisis care standards for staff – which typically allow fewer staff to cover more space and beds than they would otherwise be – have been in place since November. But the state has not promulgated its triage standards, which dictate how hospitals should deploy their resources if they are overwhelmed.
Mehta led the effort in November to rewrite the yard standards. At the time, COVID-19 hospitalizations were at their highest level in a year. Even more pressing was the spiraling staff crisis, coupled with an influx of typical hospital patients who were sicker than patients before the pandemic.
The state has not had to activate its crisis care standards for triage, which many providers say would be the worst-case scenario and a sign of the extreme and near fracking pressure being placed on hospitals here. But Mehta said on Friday that many hospitals were already using the strategies outlined in the plan.
âI mean, I think we are there,â he said when asked if the state should institute the rest of the crisis standards. Anecdotally, he said, he has heard of providers who either discharge patients early or refer patients from emergency rooms to outpatient care elsewhere, instead of admitting them, as long as it is safe. These two strategies are key elements of the crisis standards.
But the problem, Mehta continued, is that these decisions don’t happen consistently. Crisis Standards, if activated by Polis statewide, would give detailed guidance on how to ration resources fairly and consistently, in a way that could be followed.
Welch said that adopting the standards is “certainly the end of the road that we are trying not to reach.” She said hospitals were still able to transfer patients between themselves, which meant there was still some flexibility within the Colorado hospital system.
“But I think the crisis standards are still there as the last major lever that we have to pull,” she said. “It looks like we are still moving in this direction as the number of cases and hospitalizations continues to rise and our staffing issues continue.”
Mehta said Colorado’s hospital system would benefit from activating crisis standards, for several reasons: it would provide liability protection to hospitals that make those decisions; it would centralize decision-making about patients away from providers who treat them directly; and it would ensure that common inequalities in health care do not perpetuate.
It would also serve as a wake-up call to the state, he said, and help healthcare providers who are already past the point of exhaustion.
“It’s hard to imagine mental health getting worse, but it will obviously get worse,” he said. âI have no doubts about it. I couldn’t imagine it getting worse (six weeks ago) and worse (now). We don’t know what the floor is for workers’ mental health at health. It’s gonna be lousy soil because my God, the people who keep showing up for their jobs every day – how do you define that as anything other than a hero? ”